Diamond, Katharine i
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ry�` Katharine D.Diamond Female
' Date of Death Age If Veteran of U.S. Armed Forces,
=r 11/08/2018 75 Years War or Dates
Place of Death Hospital, Institution or
riCity, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death J Natural Cause 0 Accident 0 Homicide 0 Suicide D Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Michael Miles MD
Address
100 Park St,Glens Falls,New York 12801
- r= Death Certificate Filed District Number Register Number
A City, Town or Village Glens Falls 5601 527
®Burial ' Date 1 Cemetery or Crematory
11/14/2018 West Glens Falls Cemetery
❑Entombment Address
❑Cremation Queensbury, New York
- I—I Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
-
Q Disinterment Date Cemetery Address
h'. Date Cemetery Address
1❑Reinterment
rR Permit Issued to Registration Number
,,, Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
t " 407 Bay Rd,Queensbury,New York 12804
;�- Name of Funeral Firm Making Disposition or to Whom
14 Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/13/2018 Registrar of Vital Statistics go6ertA Curtis(ECectronica((ySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
al Date of Disposition 1 1 /1 4/201F8ace of Disposition West Glens Falls Cemetery
I (address)
V1 Denton Family Plot
It (section) (lot number) (grave number)
aName of Se ton or Person in Charge of Premises Conn; P T. Goedert
Z (please print)
W Signature ' Pf 4 Title Cemetery Superintendent
(over)
DOH-1555(02/2004)